International Journal of Medical, Pharmacy and Drug Research (IJMPD) https://dx.doi.org/10.22161/ijmpd.2.1.2
[Vol-2, Issue-1, Jan-Feb, 2018] ISSN: 2456-8015
Abu Dhabi Healthcare System- Diagnosis Related Group Perspective Saeed Hussein & Dr. Immanuel Azaad Moonesar R.D. Mohammed Bin Rashid School of Government, U.A.E Abstract—Abu Dhabi Health Authority legislates the Diagnosis Related Group (DRG) system as a payment method for inpatient hospital services in both public and private sectors. The purpose of this research policy paper is to provide an insight into the DRG system in Abu Dhabi Healthcare system in developing an understanding of the process involved concerning DRG including the legislative arm, the healthcare providers and the payers. Besides, this brief evaluates the DRG system from the end user, which is then, compared public and private healthcare sector where policy recommendations and associated implications are highlighted. Keywords—Health Insurance, Health Policy, Healthcare Systems. I.
DIAGNOSIS RELATED GROUP: SYNOPSIS The Health Authority of Abu Dhabi (HAAD) legalized all characteristics of health insurance in late 2010, including all issues related to payment and compensation. Such mandates stipulated for the adoption of DRGs for reimbursement of inpatient services for the essential product. The Abu Dhabi government-subsidized insurance product for low-earning citizens including the claims from health sectors including all hospitals, public or private. Abu Dhabi Health Services commonly referred to as SEHA (phonetic rendering Arabic word for ‘health’), the holding company for the public hospitals Abu Dhabi has already chosen DRGs on a voluntary basis for all of their inpatient cases and the providers. According to HAAD, the introduction of DRGs was to deliver on its commitment to improving efficiency incentives for providers to support for better comparability of both costs and quality as well as to appropriately reimburse public hospitals for their higher complexity of cases (Warner et al., 2011). Diagnosis Related Groups (DRGs) are just one type of payment methods for the hospital where it gained its popularity after their adoption to be used in the national Medicare prospective payment system in late 1983 in the United State of America (Congress, Office of Technology Assessment, 1983). The fundamental conception of DRGs is based on the averages. The providers of healthcare are paid based on nature and severity of illness not length of hospitalization or number of procedures for a lab test that has been ordered or medication has been dispensed or administered to the patients (Hamidi et al., 2015). www.aipublications.com
II. HISTORY OF DRG Medicare was established in 1965; Congress approved the private health insurance sector's "retrospective cost-based reimbursement" scheme as a payment method for hospital services. Where Medicare made periodic payments to hospitals during the hospital's fiscal year. The hospital expected to file a cost report by the end of fiscal year and the interim payments to be agreed with the allowable costs that were mentioned in the policy and regulation. Medicare's hospital costs under this payment system amplified dramatically; between 1967 and 1983, costs increased from $3 billion to $37 billion yearly (Mihailovic et al., 2016). In 1982, Congress ordered the construction of a prospective payment system (PPS) to control costs. Congress studied the achievement of State rate regulation systems in costs controlling and mandated the application of a prospective payment system framework that had been fruitful in several States. This system is a per-case reimbursement technique under which inpatient admission cases are alienated into relatively similar categories named diagnosis-related groups (DRGs). In DRG prospective payment scheme, Medicare pays hospitals a flat amount per claim for inpatient hospital care so that effective and efficient hospitals have a real incentive of being efficient and inefficient hospitals are motivated to become better organized and to improve their efficiency (Mihailovic et al., 2016). Although DRGs development started in the late 1960's the first version to be largely spread was consist of 383 categories after that in early 1982 second revised set of 467 categories was released. Both versions were designed to distinguish patients with comparable predicted resource utilized for management and to link it to the hospitalization period or length of stay in the hospital during that admission. The former version was developed by New Jersey hospital using data of around 500,000 patients but the revised version based on the nationally representative sample of patients (United States Congress., Office of Technology Assessment, 1983). III.
ABU DHABI HEALTH AND THE DRGS SYSTEM Starting from January 2006, all populations of Abu Dhabi are covered by a new widespread health insurance program; costs will be shared between employers and Page | 14